Healthcare Provider Details

I. General information

NPI: 1053374363
Provider Name (Legal Business Name): ERLINDA SANTOS CRUZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 ATLANTIC AVENUE
BROOKLYN NY
11208
US

IV. Provider business mailing address

80 MARCUS DR PROVIDER ENROLLMENT
MELVILLE NY
11747-4230
US

V. Phone/Fax

Practice location:
  • Phone: 718-647-0240
  • Fax: 718-277-8203
Mailing address:
  • Phone: 631-391-7889
  • Fax: 631-454-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number143860
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: